Diabetes

Question 1

Regular insulin Regimen?

Answer 1

take 30 minutes before meal.
lasts 6-8 hours

peaks in 2

w/ intermediate

Question 2

Split and mixed regimen?

Answer 2

regular or short acting insulin w/ intermediate before breakfast and dinner

Question 3

Split and mixed with bedtime intermediate?

the second intermediate-acting insulin can be held until

Answer 3

bedtime (9pm)

this improves morning fasting reading control.

Question 4

Regimen in multiple pre-meal injections and bedtime long acting?

what is it good for?

Answer 4

Bfast: short acting

lunch: short
din: short
bed: long (glargine) —can split for 5 daily injections

maintain blood glucose level

Question 5

What is the only thing better than pre-meal injection and bedtime?

Answer 5

insulin pumps

if they on pump you don’t do regimen

Question 6

Missing an insulin dose may cause

Answer 6

diabetic ketoacidosis

Question 7

What are the actions of insulin?

Answer 7

Increase storage of glucose as glycogen 
increase glucose utilization
stimulate transport of glucose to cells
increase fat storage 
increase fat synthesis in liver
increase protein synthesis

Question 8

suppresses glucose production while fasting

Answer 8

Basal insulin.

about 50% of daily needs.

Question 9

What is prandial insulin and what does it do?

Answer 9

mealtime insulin

limit hyperglycemia after meals
peaks 1 hr after injection 10-20% of daily dose.

Question 10

Most pts should be insulin treated with

Answer 10

multiple daily prandial and a basal injection

or

continuous SubQ insulin fusion

Question 11

You should match prandial dose to

Answer 11

carb intake
premeal blood glucose levels
anticipated activity.

Question 12

normal ranges of glucose?

Answer 12

80-120

check 6-10x a day
before meal/2 hr peaks/ bedtime/ 2 am once a month

Question 13

When insulin is too high, missed meal, strenuous exercise?

symptoms?

Answer 13

Hypoglycemia

headache/
fatigue/
hungry/
tachycardia/
sweat/anxiety/confused/
weak/fainting/
numb at fingers and mouth due to Epi release.

Question 14

Tx of hypoglycemia

Answer 14

15-20 g of glucose. for someone w/ <70 mg/dL

recheck in 15

Question 15

Risk factors for hypoglycemia:

Answer 15

old
dec food intake
long standing disease (many to notice)/ >10 years
recent episode
cog impairment
infection
alcohol/renal dysfx

Question 16

How can risk of nocturnal hypoglycemia be minimized?

Answer 16

20% reduction in daily basal insulin dose

low glycemic index carb feeding after exercise.

Question 17

Sxs of ketoacidosis?

Answer 17

thirsty
nausea/vomit/ab pain
SOB/weak
Fruity-scented breath
confusion
hyperglycemia
high ketones

Question 18

hyperglycemia signs

Answer 18

weak/tired
a lot of peeing
increased thirst
dec appetite
blurry vision/fruit breath
itchy/dry skin
seizure
coma

Question 19

MOA of incretin mimetic?

Answer 19

glucagon like peptide.
given 2x a day.
helps preserve beta cell function in pancreas.

suppresses appetite/inhibit glucagon secretion
reduce gastric emptying

Question 20

ADRs on incretin mimetic?

Answer 20

nausea, vomiting, diarrhea, risk of mild to moderate hypoglycemia when used with a sulfonylurea so reduce sulfonylurea dose

Question 21

hormones that stimulate insulin secretion in response to meals?

2 types?

half-life?

Answer 21

incretin: in GI

glucagon insulinotropic peptide: K cells in duodenum.jeju

glucagon like peptide in L cells.
half life is 2 mins.

Question 22

What is the Fx of incretin?

Answer 22

stimulus to insulin secretion when food is ingested
inhibit glucagon secretion
slow gastric emptying and reduce appetite.

Question 23

MOA for sulfonylureas

type 2

Answer 23

long acting insulin secreatogues (inc secretion)

block ATP sensitive K+ Channels on b-cell plasma membrane, suppress glucagon
STIMULATE APETITE
cause weight gain

Question 24

ADR of sulfonylureas

Answer 24

hypoglycemia (when u miss meal)
weight gain
bind to albumen

careful with old ppl with renal disease

not for preggo/lactating.

Question 25

What to not for sulfonylureas?

Answer 25

they cause release of insulin so if u cant produce it, you shouldn't take it. take 30 min before, lasts 6-8 hrs.

Question 26

Lispro?

Answer 26

short acting insulin 5 mins b4 meal, peak at 1 hr. lasts 3-5 hours

Question 27

Glarine ?

Answer 27

Peakless insulin: lasts 24 hours. replaces basal level insulin acts like continuous pump.

Question 28

NPH:

Answer 28

intermediate insulin takes long to absorb but lasts long. mix of insulin and crystalline zinc

Question 29

If someone takes a mix dose of regular insulin and NPH, when is it most likely that a hypogly

Answer 29

before lunch: reg insulin may still be effective and NPH could also effect causing hypoglycemia

Question 30

What does metformin do?

Answer 30

``` reduce gluconeogenesis in liver stimulate glycolysis improve glucose utilization reduce carb absorbtion increase fatty acid break down. reduce LDLs and triglycerides increase insulin binding weight loss NO HYPOGLYCEMIA ```

Question 31

When do you use metformin?

Answer 31

first choice unless renal/hepatic issues. ``` for polycystic ovary syndrome can be used with sulfonylureas fitazones DPP-4 inhibitors insulin ```

Question 32

ADRs for Metformin?

Answer 32

nausea/diarrhea/lactic acidosis B12 deficiency caution with renal/hepatic and people over 80 first line of Tx for T2betes.

Question 33

Exercise considerations?

Answer 33

``` 150 a week. -if glucose >250 mg before ex, check for ketone and take insulin and wait til they drop -if glucose less than 100, take carbs. -dont inject at exercise site -dont exercise at peak insulin. - ```

Question 34

Best time for T1D to exercise?

Answer 34

After Breakfast check glucose before bed man.

Question 35

Regular training increases____

Answer 35

muscle capillary density oxidative capacity lipid metabolism insulin signaling proteins.

Question 36

Mod exercise type 1 glucose utilization catecholamine response Blood Glucose MAx sprint?

Answer 36

Increase increase decrease decrease increase increase

Question 37

MOA of glitazones.

Answer 37

insulin sensitizer increase in muscle, liver,fat improving resistance. improve fat and cholesterol levels delay progression of diabetes

Question 38

ADR of glitazones

Answer 38

``` fluid retention weight gain increase risk of Fx bladder cancer. maybe increase MI? ```

Question 39

What are other areas glitazones work at?

Answer 39

islet cells of pancreas to enhance secretion of insulin over long term. prevent regression of beta cell Fx.

Question 40

Info on glucagon?

Answer 40

secreted from islet alpha cells when there is hypoglycemia to produce glucose from liver. INHIBIT INSULIN activate via ANS nerves and adrenaline

Question 41

What confirms Dx of diabetes?

Answer 41

``` Pre= FBG=100-126 A1c= 5.7-6.4 ``` Diabetes FBG > 126 A1c=>6.5